Lump in the Cheek After Wisdom Teeth Removal: Should You Worry?

Swelling after wisdom teeth removal
Our mouths are as unique as we are, so what others go through after wisdom tooth removal might not mirror your experience. Some symptoms are common, happening to most, if not all patients, while others are more uncommon.

People share stories about strange-colored spots—blue, red, green, you name it—annoying lumps, pain, swollen lymph nodes, infections, or even a strange taste in their mouth.

Knowing whether a symptom is normal or not, especially in the early healing stage, can be challenging, as everyone reacts differently to the procedure. That's why the best approach in the first week or two post-surgery is to stay calm, not overthink anything, and trust your body's healing process.

As a general guideline, if a symptom lingers beyond two weeks or gets worse over time, it might be a good idea to consult your dentist or surgeon.

In this article, we'll delve into a common post-wisdom tooth extraction symptom: A lump in the cheek or around the mouth.

A Lump in Cheek After Wisdom Teeth Removal: The Most Likely Reasons

If you've noticed a lump or any form of swelling after your wisdom teeth removal, don't panic—it's completely expected during the healing process.

Most of the time, these symptoms are temporary and part of the body's natural response to surgery. Give them one or two weeks, and they should resolve themselves.

However, if the lump is getting bigger or worse over time, it's worth mentioning it to your dentist or surgeon.

Here are the most likely causes of a lump in the cheeks after wisdom teeth extraction:

1. Chances are it's an Oedema

One common reason for post-surgery swelling is edema. Edema is a natural response triggered by the body to promote healing. After wisdom teeth removal, blood vessels widen to facilitate the delivery of essential cells and nutrients to the surgical site. The result? Redness, warmth, tenderness, and noticeable swelling in the area around the wound, including the cheeks, lips, chin, and under the jaw.

The intensity of edema varies among individuals. While some experience mild swelling, others may find it more pronounced, resembling a full-mouth feeling.

Swelling timeline after wisdom teeth removal

Typically, edema starts within the first 24 hours after the procedure, reaches its peak around 48-72 hours, and gradually diminishes within 7-10 days post-surgery.

Tips to Reduce Edema

Managing swelling is essential for a smoother recovery. Here are some tips to reduce edema after wisdom tooth removal:

  • Ice Application in the First 24 Hours: Apply ice to the affected area for 20 minutes every hour during the initial 24 hours. To prevent skin damage, always wrap the ice in a cloth or towel. Avoid prolonged use beyond the first day, as excessive cold can narrow blood vessels too much and slow healing.

  • Transition to Warm Compresses after 24 Hours: Once the initial 24-hour period has passed, switch from ice to warm, moist compresses. This helps to relax and relieve pressure in the swollen area.

  • Adjust Sleeping Posture: For the first two nights post-surgery, keep your head slightly elevated while sleeping. This positioning helps minimize facial edema.

2. Hematoma: When Bleeding Goes the Wrong Way

If you're noticing skin discoloration after your wisdom teeth removal, it's usually bruising—a temporary pooling of blood that has leaked into the deep soft tissues.

In some cases, blood accumulates in a concentrated area, creating a spongy, rubbery, and lumpy lesion known as hematoma. It often appears blue but can also be black, green, or yellow.

While it can look alarming, hematoma formation is usually a transient condition that should resolve on its own within 5 to 10 days.

Speeding Up Hematoma Removal

The good news is that hematomas naturally fade away as the body absorbs and eliminates the accumulated blood. To speed up the removal process, follow the same recommendations provided for edema. Apply cold compresses during the initial 24 hours and transition to warm compresses in the subsequent days.

3. The Lump May Point to an Infection

While complications following wisdom teeth extraction are rare, it's crucial to recognize the telltale signs of infection. This will let you act quickly to prevent it from spreading further.

Infections can sometimes manifest as a lump inside the cheeks or near the surgical site, signaling pus buildup. This occurs when bacteria invade the wound, affecting underlying bone or surrounding soft tissues in areas such as the cheeks, lips, neck, and below the tongue. The condition where the infection spreads to the facial tissues is called cellulitis.
Dental infection spreading below the lower jaw
Various factors influence infection risks, especially the procedure complexity and the nature of the extracted tooth.

For instance, longer and more challenging procedures pose a greater risk of post-operative infection. Additionally, lower wisdom teeth have a higher risk than the upper ones, as the lower jaw carries less blood supply. This makes healing of lower jaw extraction sites more challenging and complications more likely.

Next comes the extraction technique and the aftercare. Infections can occur if foreign particles, such as food, bone fragments, or tooth remnants, are left in the wound.

As the infection progresses, the body tries to fight it off by triggering intense inflammation. If the cheek area is involved, you'll first notice increased redness, diffuse swelling, heat, and pain, potentially impeding eating and mouth opening.

Later, pus can accumulate to form a well-defined swelling. At this stage, symptoms begin to get worse.

Sometimes, long-lasting and unresolved infections can transition to a chronic state. The pus hardens and forms a firm, purplish lump. It can occasionally find a way to drain through the skin via a pathway known as a fistula.

Hard lump on cheek due to chronic dental cellulitis

Infection vs. Normal Healing

It's easy to get confused between the beginning of an infection and the regular healing process, as both may exhibit similar symptoms like swelling, redness, and pain. However, certain specific indicators should prompt you to take action:

  1. The wound is filled with a gray or black substance.

  2. Pus is oozing from or near the extraction site.

  3. Lingering unpleasant taste or persistent bad breath.

  4. Systemic signs like fever, fatigue, and swollen lymph nodes under the jaw.

  5. Symptoms intensifying over time rather than improving.

How is Infection After Wisdom Tooth Removal Treated?

If you suspect an infection, visit your dentist or surgeon as soon as possible to prevent it from progressing.

Infections following wisdom tooth extraction are typically treated with antibiotics, often combined with anti-inflammatories and painkillers. In cases where the infection has led to a lump or lesion on the face, your dentist or surgeon may need to make a small incision to drain the accumulated pus.

Preventing Infections

The best way to deal with an infection after a wisdom tooth extraction is to prevent it in the first place. Follow prescribed antibiotics before and after the procedure as directed. Never stop halfway, even if you feel better before completion.

Additionally, from the second day on, start rinsing with warm salt water to reduce swelling and bacteria load in your mouth.

4. Swollen Lymph Nodes

Lymph nodes are small lumps, scattered throughout the body and usually too tiny to feel. They consist of white cells with a primary role in monitoring the body and combating foreign agents like bacteria, viruses, and cancer cells.
Lymph nodes of the lower jaw
When an infection is detected, white cells multiply rapidly, causing the lymph nodes to increase in volume, becoming palpable and noticeable. In the case of an infection following wisdom tooth extraction, the nearby lymph glands, especially those below the lower jaw along the jawline, become activated. You'll also notice the following signs:

  1. The growth is bean-shaped and has clear borders.

  2. The size is about half an inch.

  3. The growth is soft and moves when lightly pressed.

  4. Swollen lymph nodes associated with infection are often painful.

What to Do About Swollen Lymph Nodes?

Swollen lymph nodes often signal the onset of an infection. If it’s your case, don't hesitate to discuss it with your dentist or surgeon—especially if accompanied by pus discharge, fever, fatigue, or difficulty opening the mouth. Once the infection is successfully treated, these will return to their normal size.

The Lump May Actually Arise From the Jawbone

If the wound or the socket becomes infected, bacteria can not only spread to the cheek or facial tissues but also to the underlying jawbone. It's a condition known as osteomyelitis.

Initially, the intense inflammatory reaction and fluid build-up inside the bone cause hard, painful swelling near the extraction site. 2 to 3 days without treatment, pus will accumulate, aggravating the symptoms and causing fever and malaise. The skin and gums lining the swelling also become red and tender.

While drainage of pus from the bone into the mouth may provide temporary relief, it does not remove the source of the infection. Without proper treatment, the infection persists and can damage a significant portion of the jawbone.

Cyst formation is another potential complication arising from the jawbone and manifesting as a hard mass or lump.

cyst on the jaw after tooth extraction

Unlike other complications, a cyst's growth is not an overnight process. It takes months or even years to become noticeable. Usually painless and progressing slowly, a cyst can reach a significant size, deforming the jawbone and face.

A Lump After Wisdom Teeth Removal is Often Temporary

Again, the lump or swelling you are experiencing in the initial two weeks post-surgery is likely normal and temporary. These can be attributed to common reactions like edema, bruising, or blood pooling—natural and expected body responses after surgery.

So, instead of constantly checking the surgical site, prioritize rest and follow your dentist's instructions.

While these symptoms should naturally improve and regress over time, if they persist longer than two weeks or worsen, don't hesitate to contact your dentist or surgeon. They are best placed to differentiate between what should be considered normal and potential problems, depending on your specific situation.

When Should You Be Concerned?

Complications following wisdom tooth extraction are rare. Still, it's important to watch out for specific signs that may indicate potential infection or other serious complications.

Swelling or lump formation associated with pus leakage, fever, fatigue, swollen lymph nodes, throbbing pain, difficulty breathing and opening the mouth indicate a spreading infection. In such cases, prompt treatment is essential to prevent the infection from advancing.

In extremely rare instances, another potential complication that manifests as swelling is called subcutaneous emphysema. It occurs when air infiltrates the wound and diffuses under the skin of the face and neck.

Subcutaneous emphysema appears suddenly, or a few hours after the procedure, as a large swelling and, when touched, makes a weird sound. While most often benign and temporary, air can occasionally diffuse into vital areas such as the heart and lungs.

To minimize the risk, avoid coughing, smoking, or blowing hard in the first few days after surgery. This not only helps prevent emphysema, but also prevents the blood clot from dislodging. The blood clot that forms immediately after surgery is vital for healing, as it stops bleeding and protects the wound while the tissue regenerates.